I have been struggling for some time now to articulate my growing alarm in how we come to grips with the bewildering way we work on mental health. In London Ontario mental illness has increased 132% since 2003 and the question I have to ask is why was there an increase given the attention mental health has received? Today is Bell Lets Talk and this is a laudable effort by Bell Media to create conversations and awareness around mental illness. Yet I would argue that there has been no significant change in how we address the causes, or in the the access to care, for those with a mental illness. So I have to ask “Do we know what we are doing?”
I believe, deeply , that this is not the fault of organizations like CMHA, CAMH, Vanier, Ways, Family Service Thames Valley, or any other agency locally or provincial.These agencies act on the priorities of funders such as governments and foundations.They make the best case they can for funding services largely based upon how funders believe we should be addressing this issue. Yet we don’t really seem to be making any progress on moving the needle significantly on mental health so my next question is “ Do funders understand where we should be focusing our efforts?”
Let me also make you aware that other issues come into play when we speak of mental illness. Poverty is the greatest cause of mental illness and my friend Abe Oudshoorn laid out a compelling case about this and how we discuss mental health. Take some time to read Abe’s important blog on this.
I believe that in order to make significant progress on creating the conditions for recovery we have to address three main areas. The first is obvious and that is funding. In mental health, funding is significantly lower than for other health issues and if you are a child or youth the funding is even lower. In any issue in which the most vulnerable are supported, funding is the gas in the tank to power the motor toward a sustainable system of care.
All too often the discussion of funding conditions for sustainable recovery are drowned out in the media and online by cries of taxes being to high. As a matter of fact this issues, and others, cannot be heard over the hue and cry of MY TAXES ARE TO HIGH. The result is that politicians, especially during elections, are fully engaged in the dance politic and issues of poverty and mental health are left on the side hoping someone will ask them to dance. This is our fault fellow citizens. The narrative we create is about our money when perhaps it should be about compassion and care. If we collectively change the tune then perhaps issues of care for the most vulnerable will be asked to the dance .
The second area is all about the funders themselves. From the Federal, Provincial, and Municipal governments the narrative is more about accountability than it is about quality and efficacy of care. The same is true of foundations and other funders locally, provincially, and nationally. Rather than ensuring the way we are addressing issues of wellness are responsive, effective, and adaptable , we end up with a system that adheres strictly to the regimes of outputs and outcomes. There is very little opportunity to sustainably test new approaches and implement them in our systems. Rather there is an endless series of pilots and initiatives that are rolled out with a lot of fanfare but usually end up being shelved and never implemented. So unless we the citizens, and the funders who we support, frankly get revolutionary about the criteria for funding and reporting then there will be no change.
The third and final area is planning. I believe the way we now plan how to respond to mental health, or any other social issue, is so woefully inadequate that we end up with a patch work system of care that has become a culture of fractured intentions rather than a meaningful eco-system approach. Each of the players on this field, from funders to agencies, have their own mission and vision combined with a mountain of strategic plans surrounded by a public that is worried about their own individual economic well-being, that leaves an ever-increasing number of people stranded and ill. In his smart book Social Labs: A Revolution, Zaid Hassan described how we think planning works and what actually is happening when we do. Said makes the point that we live in a complex adaptive environment with massive interconnected systems that continually create ruptures in our societies. We only need look to economic train wreck of 2008 or the current value of the looney for examples of complex systems creating local ruptures. In the example on planning he points to this analogy: Imagine you throw a rock. You can pretty reasonably guess where that rock will land. You can plot its trajectory and understand the impact it will make when it hits the ground. This is how we do planning today. We create plans that say by X date we will have done X things with X number of people. But now imagine instead of throwing a rock you throw a bird. Can you reasonably plot it’s trajectory? Can you make a reasonable guess where it will land? Can you make a reasoned guess as to the impact it will make? No you cannot. You will have no idea where that bird will fly or the path it will take. So why, when we are dealing with complex macro economic forces, complex societal forces, complex interdependent systems, and the most complex of all – human beings in crisis, do we make plans based on throwing rocks when in fact we are throwing birds? Governments, funders, and agencies need to think about this seriously and invite us citizens in to come up with a different approach. There is a way to do this.
SO on this, Bell Lets Talk Day 2016, what should we be talking about? Abe did a great job of speaking to the issues of poverty and mental health, but we also need to be talking about the system and methods we create to sustainably and effectively MOVE THE NEEDLE. Right now we are not and the results, unless we are willing to make a meaningful effort, will be even more tragic than they are today.